Laserfiche WebLink
P. 3 <br /> 11-12-1997 9:04AM FROD <br /> APPLICATION FOR WELL(PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE,STOCKTON,CA 95202 <br /> (209)4693420 <br /> NON-REFUDULE PERMIT 0=1-1 TEAR FN9 DATE MVD <br /> ICN)p"In TTI 5mlel <br /> APPLICATION b NEE NY MADE TO TIE SAM JOAOtAM CO{MAY FOR A PoWff To COHSTIXICT ANDMNI*WALL THE WROW OESCRIVED•T"N APPLICATION a MADE IN COMPLMMCI wmt Sy <br /> JOAOUM COUWY DEYROPuPff TM.L CHAPTER S-t 115.3 AND THE STANDARM OF MN JOAOtMH COIMrY PUBLIC HEALTH SERRA"f.IPMRO IFF(TAL HEALTH oFAMM. c <br /> Joy AooPEStiow APNF � pry �..,..�� - <br /> o _ 6}L '..�ry cr•,.. <br /> My�.S _ ADDIEfi '� <br /> BIIB COPRTRACTOR II/ ADDRESS uct now S <br /> r&t Or j O New vmL D M %AC WWff well C3 moonomm wuL. O OTHai <br /> D MSTAUATIDN D WELL SYlTIM ROPAIR D M 0SS•COMIECT REPAMR ❑ VAPOII tXTRACTLON waL F <br /> D Nwn D R.POr N F. IMP, PUH►SET R. PRO.WATER LEVEL <br /> fly"OP rum" <br /> ❑of=oF.BERnct MM!tt D eBOPwRrelcM.weu P D sat BDI.Pa e <br /> ®'a.TISICTMIN, <br /> OEM Typt OF WELL 0096TRIXIMN 0==T= <br /> A <br /> D WMAM SAL D opt"NoTTOM DIA.OF WELL tXCAVATION aA.OF CONDUCTOR CASMO L <br /> D DOtrESTIdM11VATt D OOMAvn rACKARE TYPE OF CAEMOATwjr-lC Ow OF WELL CASMo t <br /> D MNlj0#AWlPAL D01Mvm am"oParm"SEAL arEe+FIeATTON A <br /> D wa&ATwwAS D OTNeR GROUT SEAL MRAUAD WY_ GROUT BRAND NAJIt f <br /> D maw"mmJy/� yQ,, oIwUT NEAL PRJuIFto1 D Y• D N. CONCRETE PEDESTAL M DPINJAR1 D Yr 00" 3 <br /> APPMOIL OWN_ .6..A_0- L"'"' '�'•a"� `� uxxnm pIEfTEl1 SOX1i/OVt PIPE s <br /> AIGrOSlIf AM Mff"#M AMID ROTARY AIR ROTARY AUGER <br /> 1 MERRY CERTIFY THAT I NAVE PRIEPAREO TWO APPL)CA"M ANO THAT THE wow MALL SE ONE MI ACCORDANCE WITH SAN JOAOUM COLMRY OROIHAAX:eS,RATE LAWS.ANO RUI.Et AN <br /> REOULATgMS OF THE"M JOAOtMN COMITY. HOME Ow""opt LRCtnw AGENT'S SM NATURE CENMV*o T10i POO LONAM:'I CERTIFY THAT M1 THE MWORMANCE OF THE WORK FOR NMC <br /> TNt POO=18 ttNRtD.1 MIALL NOT EMPLOY PERSONS IUB,*CT TO MOISRMAN'S COh"W"TION RANG OF MP""&* CONTRACTORS RMISHS OR SLW TRACTMO SS,"TUPE CtRTWX <br /> THE POLLOM O: '1 CLARIFY THAT M THE PEIMOIr.IANCE or TW W0M POR WHICH TNS PNBAR M MOM.I t1IA.L EMPLOY PERSONS MIBJECT TO WORM AM'S C.OMP'MSATION LAWS O <br /> CALWOF"&- THE APNICANT.MUST CALL 24 HOURS W ADVANGe POR ALL REOUIRO MSP00,10fit AT WIR 408442L COMRN1 <br /> ETt ORAVVM AT LOWWOR MEA 0VIMO. <br /> ,j,/ %S� � (•t-fl' trr?• ' O.I.'L / 7 <br /> PLOT PLAN RDmw 4 buM SSW M <br /> I. PAWN OF STREETS OR ROADS NEAREST TO OR SOUNOMID THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE OW OSAL SYSTEM OR PROPOSED <br /> E. OUtTJNE OF THE PROPERFY.GIVIPIOOWAMIRIM AND NORTH ONECTXK E UW MOH OF SEWAGE D1 GAL SYSTEMS. <br /> O. ONANNNDNM OUTLIRM ANO LOCATION OF ALL W.,O G AND PROPOSED R LOCATM OF WELLS YYTTNN RAORM OF ONE MHORED FIFTY FT, <br /> RRUCTWEB.MCLUDMO COVERED AM"NICU AS PA"M OItVEWAYS.AND WALXR ON THE PROPERTY OR ADJOROM PROPERTY, <br /> ., .f., ..._ ..5......3..... ? .. ....... ...d...... ... .....: ..j.. : ...3......:. <br /> ..... 7.. .�. ..j.•... .....4.....�j... . .... ..o... ..q........ ... ... <br /> .±.....+...'.. ..i... ....�. ..,. ..I.. .'i.........:'� <br /> OSPMTMMT INH ONLT <br /> t>,.ur 6r..wl.n Bp D.M K~Mn.wSwl h a— <br /> ACCo1MHN0 ONLY: ADM FAC) <br /> M Coop mow AMOWPT Kim—go ASN RIDOVN!NY OATS POMNTIS NVMV REQUEST MWASIR MRIOIDE <br /> S OZ, 2 ! / 7� <br /> Pub.HSBIfh Som.-Emft.173('Ar?) <br />